Subtle Lisfranc injuries

diagnosis and treatment

Abstract

Introduction: Subtle Lisfranc injuries are produced by low energy traumas. They are frequently subdiagnosed and their treatment is controversial. The objective of our work was to review different diagnostic and therapeutic strategies for the management of subtle Lisfranc injuries. Methods: A bibliographic review in Medline (Pubmed interphase) and OVID databases was made, including studies of the last 17 years referring to pure ligamentous Lisfranc injuries or with osseous avulsions. Data concerning the clinic presentation, classifications, imaging studies, treatments and results was drawn from each study. Results: 13 studies including a total of 113 patients were found. Most of the injuries were produced in athletes, ground level falls or low energy traffic accidents. Bilateral weightbearing radiograph was the imaging study most used for the diagnosis. The radiographic criteria better used was the diastasis more or equal to 2mm between the base of the first and second metatarsal bones. The utmost elected treatment was the surgical one. The AOFAS score in order to evaluate the postoperative result was used in most of the cases. Conclusions: Bilateral weightbearing radiograph was the imaging study greater used for diagnosis and is frequently complemented by MRI or CT if necessary. There is consensus in the analyzed studies that the surgical treatment is better than the orthopedic one concerning unstable injuries. It is not established which is the best implant to fix the Lisfranc articulation. A diagnostic and therapeutic algorithm with the objective of systematizing the approach for these injuries was created to be used in our hospital.